Do Nasal Steroids Stunt Growth?

Cornelius W. Van Niel, MD reviewing Skoner DP et al. Pediatrics 2015 Feb.

Nasacort was associated with a small but statistically significant decrease in growth velocity compared with placebo.

A new practice guideline (Physician's First Watch Feb 3 2015) advocates the empiric use of nasal steroids as first-line therapy for allergic rhinitis in children aged 2 years and older. Inhaled corticosteroids have been associated with decreases in linear growth, but conflicting results and study design weaknesses led the FDA to publish guidelines for pediatric clinical trials evaluating inhaled corticosteroids and growth. In an industry-supported study conforming to these FDA guidelines, researchers randomized 299 normally growing children (age range, 3 to 9 years) with skin test–positive perennial allergic rhinitis and active symptoms to receive triamcinolone acetonide aqueous nasal spray (Nasacort; one 55-µg spray in each nostril daily) or placebo.

About 75% of children took the nasal spray 75% of the time. Mean growth velocity during the 12-month treatment phase was significantly lower in the Nasacort group than the placebo group (5.7 vs. 6.1 cm/year). The difference appeared within the first 2 months of treatment, and this gap did not widen significantly from months 4 to 12. During 2 months of follow-up, growth velocity decreased slightly in the placebo group and increased slightly in the Nasacort group. No differences in bone age or urinary free cortisol appeared between groups.

Citation(s):

Skoner DP et al. Intranasal triamcinolone and growth velocity. Pediatrics 2015 Feb; 135:e348.